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General NPI Number Information
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NPI Number | 1205453206
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Entity Type | Individual
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Provider Name | TAYLOR MICHAEL PEDEGO DDS
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Gender | Male
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Dates
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Enumeration Date | 06/25/2020
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Last Update Date | 09/19/2023
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Provider Practice Location Address
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Address Line | 3025 W 38TH AVE
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City | DENVER
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State | CO
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Zip | 80211-2001
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Country | US
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Telephone | 303-458-7051
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Fax |
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Provider Business Mailing Address
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Address Line | 4858 BENTON ST
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City | DENVER
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State | CO
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Zip | 80212-2708
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Country | US
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Telephone | 978-886-7560
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 61085244
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DEN.00204922
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License Number State | CO
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